Fraud Cases

Michael Baer pled guilty to submitting over $20,000 in fraudulent insurance claims and for using “runners” to bring in patients. Between May and November 2000 Baer submitted claims to Parkway Insurance Company and Hanover Insurance Company for services that they did not provide. He also admitted to hiring runners who bring in patients so a medical provider can bill their insurance.

A New Jersey neurologist was charged with health care claims fraud in June, 2003. Barry M. Vogel allegedly submitted more than $54,000 in healthcare insurance claims for tests and other services that were not provided. Vogel allegedly submitted false claims to Prudential Property & Casualty Insurance Company for electro-diagnostic tests and nerve conduction velocity tests.

June 26, 2003 Dr. David Mitzan pleaded guilty to charges that he forged prescriptions for Oxycontin and billed his insurance company for the drugs. Oxycontin is a time-released pain reliever that is often abused and is the cause of many crimes.

A Redding attorney filed a lawsuit on behalf of 82 people who had heart procedures at Redding Medical Center, who believe their treatment was unnecessary. Redding Medical Center, Tenet Healthcare Corp., cardiologist Chae Hyun Moon, and heart surgeon Fidel Realyvasquez Jr were named in the suit, which alleges fraud, intentional infliction of emotional distress, conspiracy, wrongful death, and other allegations.

In a sting known as “Operation Headwaters,” FBI agents found a company allegedly advising other companies how to get reimbursed for their products, even though the products are not covered by Medicare.

Mike Fitzgerald covered the story in the Belleville News-Democrat. He contacted Mathias Consulting to find out more about Medicare fraud:

“Medicare is a tempting target to scam artists because it is an entitlement program. Most of its annual budget comes from the pockets of taxpayers, and not directly from its elderly customers, said Robin Mathias, a health care fraud investigator based in Santa Rosa, Calif.

‘You don’t have the same kind of natural built-in controls that you have for credit-card fraud,’ Mathias said, ‘because the customer, the patient, often doesn’t see the billing or have as much interest in making sure it’s accurate.’”

Kansas Medicaid paid Pamela Sayers almost $20,000 for services she did not provide to her grandmother. Sayers was a Home and Community Based Services attendant. She submitted false time sheets for home based services for her grandmother, but her grandmother was in a nursing home at the time.

Mark Sharp was convicted of more than $1.6 million in fraudulent Medicaid billing in Georgia. Sharp’s “Center for Families” mental health centers contracted with psychiatrists and psychologists to provide mental health services to Medicaid recipients, and Sharp’s company handled the billing.

Dr. Aubrey Camacho, an obstetrician in Georgia, made his living ripping off Medicaid. To get higher reimbursement, Camacho billed Medicaid for Caesarean deliveries when he performed vaginal deliveries. He billed for patients who didn’t even know who he was and for seeing patients when he was not in the office. He also billed Medicaid for sonograms that were not provided or were not medically necessary, including 92 sonograms for one patient.

State auditors in Connecticut uncovered a durable medical equipment scam in 1998, finding that three DME companies routinely used the ‘miscellaneous’ code to bill up to $499 per item (billing $500 or more would have attracted attention). Each of the companies allegedly failed to maintain physicians’ prescriptions, failed to maintain invoices to support billing and billed for non-covered items.

Rayonne Clark pleaded guilty to Medicaid fraud for her role in fraudulently obtaining admission into the Medical Family Care Program. She worked for Maximus, a contractor hired by New Jersey to assist eligible residents obtain health insurance and other medical benefits.